Palliative Care Competence Framework

Transcription

1 Palliative Care Competence Framework MEDICINE NURSING MIDWIFERY HEALTH CARE ASSISTANTS SOCIAL WORK OCCUPATIONAL THERAPY PHYSIOTHERAPY SPEECH AND LANGUAGE THERAPY DIETETICS / CLINICAL NUTRITION PHARMACY PSYCHOLOGY CHAPLAINCY/PASTORAL CARE 1

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3 Palliative Care Competence Framework 2014 This report should be cited as follows: Ryan K, Connolly M, Charnley K, Ainscough A, Crinion J, Hayden C, Keegan O, Larkin P, Lynch M, McEvoy D, McQuillan R, O Donoghue L, O Hanlon M, Reaper-Reynolds S, Regan J, Rowe D, Wynne M; Palliative Care Competence Framework Steering Group. (2014). Palliative Care Competence Framework. Dublin: Health Service Executive Or Palliative Care Competence Framework Steering Group. (2014). Palliative Care Competence Framework. Dublin: Health Service Executive 3

4 Published by: Health Service Executive, Dublin ISBN Health Service Executive Palliative Care Competence Framework. This work is licensed under the Creative Commons Attribution-Non Commercial 4.0 International License. To view a copy of this license, visit 4

5 CONTENTS Foreword...6 Joint Message...7 Statements of Support...8 Membership of Steering Group...10 Acknowledgements Introduction...12 Palliative Care...12 Competence Framework Development...14 Method...14 The context of the Palliative Care Competence Framework...15 Domains of Competence...15 Core Competences for Palliative Care...17 Discipline Specific Competences Medicine...20 Nursing...34 Midwifery...56 Health Care Assistants...64 Social Work...72 Occupational Therapy...86 Physiotherapy Speech and Language Therapy Dietetics/Clinical Nutrition Pharmacy Psychology Chaplaincy/Pastoral Care References Appendix Appendix Appendix

6 FOREWORD As a society, perhaps the most sensitive measurement of our maturity is the manner in which we care for those who are facing the ultimate challenge the loss of life. (Report of the National Advisory Committee on Palliative Care, 2001) The provision of high quality palliative care is a central responsibility of the whole health care system. It is essential that health and social care workers possess the right competences to effectively meet the needs of people with life-limiting conditions as they are among the most vulnerable of populations served by our health service. The development of the Palliative Care Competence Framework is a valuable tool in supporting staff to achieve this goal and serves as a signal of the areas of performance that are valued by the Department of Health. Competences represent a dynamic combination of knowledge, understanding, skills and abilities. The purpose of continuing professional development is to foster competences and it is envisaged that the framework will initially be used by individuals and managers to identify specific training needs. The framework will also serve to focus dialogue when evaluating practice needs or demands. Furthermore, the development of the framework affords a valuable opportunity to articulate and further our understanding of discipline-specific and inter-professional competences. This is particularly important as teamwork is an integral part of the philosophy of palliative care. Effective coordination and collaboration can occur only when each profession knows and uses the others expertise and capabilities in a patient-centred way. I would like to thank all the individuals and representative professional organisations who gave so generously of their time and expertise in the development of this framework. As we work to meet the challenges posed by increasing demands for palliative care associated with our ageing population and greater incidence of chronic illness, I encourage you to read and share this document with your colleagues. Kathleen Lynch T.D. Minister for Primary Care, Social Care (Disabilities & Older People) and Mental Health 6

7 JOINT MESSAGE Joint Message from the National Director of Clinical Strategy and Programmes and the Clinical Lead, National Clinical Programme for Palliative Care The National Clinical Programme for Palliative Care continues to make a significant contribution to improving the care for patients, their families and society as a whole by focusing on our most important resource, our staff. The development of the Palliative Care Competence Framework highlights the ability of the National Clinical Programmes to bring key stakeholders and professions together to work collaboratively. The framework supports health care staff in all care settings to self assess, develop and maintain skills, knowledge and attributes required for the provision of palliative care. This framework will help to embed a culture within our services to ensure high quality safe services for patients. It also provides a template for our partners in education and professional development to support health care professionals by including palliative care competences in education programmes at all levels. This framework places a focus on the person with a life-limiting condition and their family. It helps in determining what health care staff can do to alleviate distress, pain and discomfort whether this is physical, emotional, spiritual or psychological. Applying the core and specific competences in practice, will help all health care staff (based in a hospital, hospice, GP practice, primary care centre or a community based setting) working with social care partners, to recognise their role in palliative care and to develop their own quality improvements. The National Clinical Programme for Palliative Care and its partners will work with all stakeholders in order to ensure palliative care is at the heart of our health care service. We are grateful for the support and enthusiasm from all stakeholders to date and look forward to building on this to meet our objective of improving the quality of life of people with life-limiting conditions. Dr Áine Carroll, National Director, Clinical Strategy and Programmes Dr. Karen Ryan, FRCPI Clinical Lead, National Clinical Programme for Palliative Care 7

8 STATEMENTS OF SUPPORT In my role as Chairman of the Forum of Irish Postgraduate Medical Training Bodies I am very happy to both endorse and congratulate all those who have put together this Palliative Care Competence Framework. The Forum was established in 2006 with the aim of enhancing the effectiveness of the training bodies in maintaining the highest standards of medical education and training. Since that time its remit has expanded beyond matters solely to do with education and training but also into areas of professionalism and service provision, specifically focusing on the development of clinical leadership; whilst recognising, at the same time, the importance of team working and the pivotal roles of all those health care disciplines that are our partners in providing all that is the very best for our patients. Few topics in medicine extend so widely across so many health care disciplines and care settings as Palliative Care. This kind of care is not simply about managing the physical symptoms of life threatening illness but extends necessarily into psychological, social, pastoral and spiritual support. Furthermore, the image and aspiration of the discipline of Palliative Care has changed from one of, not simply managing terminal illness and soothing the symptoms of disease and disorders, to a more positive one of wellness. As in so many areas of medicine, change and knowledge is moving apace and it is difficult enough to keep abreast with one s own area of interest let alone what is available across other fields and what other skills can be brought to the table. It is in this context that this Palliative Care Framework document sets out, so helpfully, the core competences as to the knowledge, attitudes and skills that should be required, not just by specialists and part-time practitioners, but by all health care workers who look after patients with life-threatening illnesses. These competences are set out against six domains and across ten disciplines ranging from medicine and nursing to dietetics and nutrition and pharmacy. Providing this information under the umbrella of a single document will not only promote better, harmonious and standardised care but will, I have no doubt, significantly improve the quality of life of patients and their families across Ireland and who are faced with all the problems associated with such a life-threatening illness. Professor Frank Keane Chairman, Forum of Irish Postgraduate Medical Training Bodies The Nursing and Midwifery Board of Ireland (NMBI) welcome the development of the competency framework document for palliative care as a guide to ensure a common expectation of practice in all settings. Nursing and Midwifery Board of Ireland The Office of Nursing and Midwifery Services Director is very pleased to endorse the palliative care competency framework. The Nursing and midwifery profession acknowledge that professional competence is far more complex than demonstrating behaviour aspirations or undertaking a task. Collaborative decision making with service users and their families in care planning and provision requires a level of knowledge and skills that engages with values, beliefs and attitudes to make competent and effective decisions. The continuum of contemporary palliative care from early provision, concurrent with disease modifying treatments, to sole palliation recognises the increasing competency requirements on all health and social care providers. As partners in the advancement of the competences for nursing, midwifery and health care assistants we are confident of the potential of this framework to enhance knowledge, skills and development in providing positive palliative care outcomes for service users and their families. Dr Michael Shannon Office of Nursing and Midwifery Services Director I welcome the opportunity to support the publication of the Palliative Care Competency Framework. This document will be an invaluable resource that will support standards of clinical practice in Palliative Care and ultimately enhance the quality of patient care and experience. Additionally, it will assist education providers and influence curriculum development in the relevant therapy professions in the future. For clinicians and employers it will be a positive tool that will help identify professional development and training needs to ensure high standards of service delivery to patients with life-limiting conditions. It will also promote interprofessional understanding of the multidisciplinary and holistic framework of Palliative Care service delivery. My thanks to the experienced clinicians & educators from the disciplines of Occupational Therapy, Physiotherapy, Dietetics & Clinical Nutrition, Speech & Language Therapy who have contributed to the production of this fine document. Emma Benton Therapy Professions Advisor, HSE Clinical Strategy and Programmes Directorate 8

9 As President of The Psychological Society of Ireland (PSI), I welcome and fully support the Palliative Care Competence Framework. The framework is an exciting and inspiring invitation to work with our colleagues from different disciplines and ensure that living and dying in Ireland is the best it can be. The framework clearly sets out the current expectations for psychologists working with individuals with life-limiting conditions and also provides a terrific guide to inform undergraduate and postgraduate curricula for the profession. I wish to congratulate all those who contributed to this very important and excellent work. I am happy to endorse the Framework and I wish it great success. I believe that it will continue to be useful, challenging and inspiring for many years to come. The document is an excellent example of collaborative practice and all who contributed should be proud of its clear communication, its practical utility and its enormous potential to bring compassionate and competent care to our citizens at life s most vulnerable times. Dr Margaret O Rourke President, The Psychological Society of Ireland The development of the Palliative Care Competence Framework is welcomed by the following professional bodies and group who have approved the discipline specific competences for their respective disciplines. Association of Occupational Therapists of Ireland ( AOTI) Irish Nutrition and Dietetic Institute (INDI) Irish Society of Chartered Physiotherapists ( ISCP) Irish Association of Speech and Language Therapists ( IASLT) Hospice and Palliative Care Social Work Group The development of the Palliative Care Competence Framework is welcomed by the Healthcare Chaplaincy Board (HCB), The Chaplaincy Accreditation Board (CAB), The National Association of Healthcare Chaplains (NAHC) and the Association of Clinical Pastoral Education (Ireland) Ltd, who have approved the discipline specific competences for chaplains. Healthcare Chaplaincy Board (HCB) Chaplaincy Accreditation Board (CAB) National Association of Healthcare Chaplains (NAHC) Association of Clinical Pastoral Education (Ireland) Ltd Irish Institute of Pharmacy is happy to support the Palliative Care Competence Irish Institute of Pharmacy The Healthcare Chaplaincy Board Chaplaincy Accreditation Board National Association of Health Care Chaplains Association of Clinical Pastoral Education (Ireland) Ltd HOSPICE AND PALLIATIVE CARE SOCIAL WORK GROUP 9

10 STEERING GROUP MEMBERSHIP Dr Karen Ryan (Chair) - HSE Clinical Lead Palliative Care, Palliative Medicine Consultant, St Francis Hospice and Mater Misericordiae University Hospital Health Service Executive Representatives Dr Regina McQuillan - Palliative Medicine Consultant, St. Francis Hospice & Beaumont Hospital Liz O Donoghue - Clinical Nurse Specialist in Palliative Care, Our Lady s Children s Hospital Dublin Morna O Hanlon - Clinical Nurse Specialist in Palliative Care, St. James Hospital Dublin Sheilagh Reaper-Reynolds - Health Service Executive General Manager Palliative Care Deirdre Rowe - Occupational Therapist Manager/Deputy Head of Clinical Services, Our Lady s Hospice & Care Services Harold s Cross Mary Wynne - Interim Area Director Nursing and Midwifery Planning & Development DNE All Ireland Institute of Hospice & Palliative Care Representatives Dr Michael Connolly - Head of Education, All Ireland Institute of Hospice & Palliative Care Karen Charnley - Programme Manager Education, All Ireland Institute of Hospice & Palliative Care Dr Joan Regan - Palliative Medicine Consultant, Marie Curie Hospice and the Belfast Trust Irish Association for Palliative Care Representatives Mary Ainscough - Chief Executive Irish Association for Palliative Care Cliona Hayden - Senior Pharmacist, Our Lady s Hospice and Care Services Prof Philip Larkin - Professor of Clinical Nursing (Palliative Care) University College Dublin and Our Lady s Hospice and Care Services David McEvoy - Medical Social Worker Specialist Palliative Care Services Meath Irish Hospice Foundation Representatives Jackie Crinion - Acting Manager of the Hospice Friendly Hospice Programme Orla Keegan - Head of Education, Research & Bereavement Services Marie Lynch - Programme Development Manager 10

11 ACKNOWLEDGEMENTS The development of the Palliative Care Competence Framework would not have been possible without the commitment of the Palliative Care Competence Framework Steering Group, Mary Ainscough, Karen Charnley, Dr Michael Connolly, Jackie Crinion, Cliona Hayden, Orla Keegan, Prof Philip Larkin, Marie Lynch, David McEvoy, Dr Regina McQuillan, Liz O Donoghue, Morna O Hanlon, Sheilagh Reaper-Reynolds, Dr Joan Regan, Deirdre Rowe, Mary Wynne, all of whom have played a crucial role in making this framework a reality. Thanks are due to the following: Chairs of the Discipline Specific Working Groups: Dr Regina McQuillan (Medicine), Prof Philip Larkin (Nursing, Midwifery and Health Care Assistants), David McEvoy (Social Work), Deirdre Rowe (Occupational Therapy, Physiotherapy, Speech and Language Therapy and Dietetics/Clinical Nutrition), Cliona Hayden (Pharmacy), Dr Paul D Alton (Psychology), Brian Gough (Chaplaincy/Pastoral Care) Brian Lee - National Programme Manager (Palliative Care, Obstetrics & Gynaecology) for co-ordinating meetings of the Steering Group and Discipline Specific Working Groups Sinéad Fitzpatrick - Programme Manager, National Clinical Programme for Palliative Care for assisting with finalising and editing the framework document. Colleagues from the Forum of Irish Postgraduate Medical Training Bodies, the Royal College of Physicians of Ireland, the Nursing and Midwifery Board of Ireland, the Therapy Managers Advisory Group, the Pharmacy Society of Ireland, the Association of Occupational Therapists of Ireland (AOTI), Irish Association of Speech and Language Therapists (IASLT), the Irish Nutrition and Dietetic Institute (INDI), the Irish Society of Chartered Physiotherapists (ISCP), the Psychological Society of Ireland, the Healthcare Chaplaincy Board, the Chaplaincy Accreditation Board (CAB), the National Association of Healthcare Chaplains (NAHC) and the Association of Clinical Pastoral Education (Ireland) Ltd and for their contributions and comments during the development of the framework Dr Claudia Gamondi - Palliative Care Physician, Palliative Care Department, Oncology Institute of Southern Switzerland, Ticino, Switzerland - for her critical review and constructive comments on the framework document Elaine Wilson Lecturer, School Of Applied Social Science, University College Dublin - for her constructive comments on the social work section of the framework document Dr Michael Connolly and Karen Charnley (AIIHPC) for their tireless work in bringing the entire document together Gareth Wescott (AIIHPC) for final editing and graphic design of the framework document Thanks are extended to the All Ireland Institute of Hospice and Palliative Care (AIIHPC), the Irish Association for Palliative Care (IAPC) and the Irish Hospice Foundation who provided both financial and personnel support for this project. The contribution of the Office of the Nursing and Midwifery Services Director to the publication of this document and their expert input to the project is gratefully acknowledged. 11

12 INTRODUCTION The Health Service Executive (HSE) Palliative Care Programme Briefing Document (2012) identified the development of a Palliative Care Competence Framework as a key objective for the coming year. The Health Service Executive s Palliative Care Programme convened a Project Steering Group to support, guide and oversee the development of the Palliative Care Competence Framework. The steering group comprises members from the Health Service Executive (HSE), All Ireland Institute of Hospice and Palliative Care (AIIHPC), the Irish Association for Palliative Care (IAPC) and the Irish Hospice Foundation (IHF). The purpose of this project was to develop a Palliative Care Competence Framework for health and social care professionals working in various health care settings. The framework is intended to provide for core competences in palliative care whilst also detailing individual competences for each health and social care discipline. It is envisioned that the framework will inform academic curricula and professional development programs, and so will enhance the care of people with a life-limiting condition, fostering greater inter-professional and inter-organizational collaboration in palliative care provision. The Palliative Care Competence Framework reflects a move to standardisation of undergraduate and postgraduate education in Europe and how this relates to the development of competence using the Tuning Approach. The Tuning Approach provides a guide for attainment of knowledge, skills and attributes for practice in the health and social care professions. The Palliative Care Competence Framework was developed using the Tuning Approach which provided flexibility and autonomy to develop both core and discipline specific competences for generalist and specialist palliative care. The outcome is a clear framework for evidence-based, safe and effective palliative care for generalist and specialist practitioners irrespective of place of practice. Palliative Care The World Health Organisation (WHO) defines Palliative Care as: an approach that improves the quality of life of individuals and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care: provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of individual care; offers a support system to help individuals live as actively as possible until death; offers a support system to help the family cope during the individuals illness and in their own bereavement; uses a team approach to address the needs of individuals and their families, including bereavement counselling, if indicated; will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. 12

13 Palliative care, both generalist and specialist, is provided in all care settings, including the community, nursing homes, hospitals, and specialist palliative care units. In recent years, the scope of palliative care has broadened so that palliative care is now provided at an earlier stage in the trajectory of both malignant and non-malignant disease. Table 1: Levels of Palliative Care Specialisation (NACPC, 2001: 32) Level 1 Palliative Care Approach Palliative care principles should be practiced by all health care professionals. The palliative care approach should be a core skill of every clinician at hospital and community level. Many individuals with progressive and advanced disease will have their care needs met comprehensively and satisfactorily without referral to specialist palliative care units or personnel. Level 2 General Palliative Care Level 3 Specialist Palliative Care At an intermediate level, a proportion of individuals and families will benefit from the expertise of health care professionals who, although not engaged full time in palliative care, have had some additional training and experience in palliative care, perhaps to diploma level. Such intermediate level expertise may be available in hospital or community settings. Health care professionals who wish to undertake additional training in palliative care should be supported in this regard by the health board or other employing authority. Specialist palliative care services are those services whose core activity is limited to the provision of palliative care. These services are involved in the care of individuals with more complex and demanding care needs, and consequently, require a greater degree of training, staff and other resources. Specialist palliative care services, because of the nature of the needs they are designed to meet, are analogous to secondary or tertiary health care services. In order to prepare health and social care professionals to apply the principles of palliative care in practice, irrespective of setting, education and training are important. Education for practice must ensure that health and social care professionals are competent to practice. In recent years competence-based education for health and social professionals has been promoted across the European Union. 13

14 Introduction Competence Framework Development Competence assessment has evolved and been influenced by the learning taxonomy devised by Bloom (1984). Competence development takes into account the incremental nature of knowledge attainment for skills based on experience and education. It also provides a basis for the development of clinical knowledge and career progression in health and social care. In a number of jurisdictions the development of competence frameworks has been influenced by the publication of a number of key documents The NHS Cancer Plan (2000) determined a strategic direction development of a national, high quality, uniform and equitable cancer service (Becker, 2007:14); RCN Core Competency Framework (2003) attempted to bring together a uniform framework for cancer nursing across four levels of practitioner and a wide variety of skills; Canadian Hospice Palliative Care Nursing Standards of Practice (2009) defined the standard of care that can be expected by all persons receiving HPC nursing and looked to guide, support and promote the provision of further education and training; National Association for Social Workers Standards for Palliative & End of Life Care (2004) (US) - standards were designed to enhance social workers awareness of the skills, knowledge, values, methods and sensitivities needed to work effectively with clients, families, health care providers, and the community when working in end of life situations; Royal Australian College of General Practitioners Curriculum for Australian General Practice (2011) (Australia) Palliative Care Sets out the training outcome of the five domains of general practice including details of learning outcomes across the GP professional life; Educating Future Physicians in Palliative and End of Life Care (EFPPEC) Canada (2006) details palliative and end of life care undergraduate curriculum which was developed to integrate end of life competencies into existing curriculum. The curriculum was approved on a Pan-Canadian basis by the 17 faculties of medicine. Educators have attempted to define the notion of competence for many years, but there is still a lack of consensus about a standard definition for competence (Becker, 2007). Competence standards do exist for pre-registration education and the proposed Palliative Care Competence Framework can assist health and social care programme co-ordinators in the updating and further development of curricula. In the context of continuing professional development, legislation now exists to ensure the maintenance of professional competence for health and social care professionals. However in some instances the legislation has specified a lead in period, so that statutory bodies have time to develop systems to support the maintenance of professional competence. Post-graduate education in Palliative Care can also be informed by the Palliative Care Competence Framework, which can provide guidance on the knowledge, attitudes and skills needed to provide palliative care in particular contexts and settings and at specialist level. Method A steering group was convened by the National Clinical Programme for Palliative Care programme to support, guide, and oversee the development of the Palliative Care Competence Framework. The purpose of the project was to develop a Palliative Care Competence Framework for health and social care professionals working in various health care settings. The framework provides for core competences in palliative care whilst also detailing individual competencies for each health and social care discipline. It is envisaged that the framework will inform academic curricula and professional development programs, and so will enhance the care of people with life-limiting conditions and their families, fostering greater inter-professional and inter-organizational collaboration in palliative care provision. An initial objective of the steering group was to analyse and evaluate existing competence frameworks, to agree the framework appropriate and applicable to the Irish context and to agree an approach to the framework development in light of this analysis. AIIHPC undertook a review of available international palliative care competence frameworks. The purpose of the review was to consider frameworks already in use in other jurisdictions in order to make an appropriate and informed recommendation to the Project Steering Group. A number of palliative care competence frameworks from the UK, US, Canada, Australia and Northern Ireland were reviewed and summarised. All frameworks reviewed 14

15 identified domains of competence with specific indicators for each. Many of the frameworks reviewed failed to indicate how the framework could inform curriculum development or support continued professional development and lifelong learning in the clinical environment. The review recommended that the Palliative Care Competence Framework should be developed in line with Tuning Competences, which provide flexibility and autonomy to develop both core and discipline specific competences for generalist and special palliative (Connolly et al., 2012). Over a series of meetings the Steering Group developed Six Domains of Competence and indicators (core competences) which describe what each health and social care professional should know at point of registration or first place of work. The core competences formed the basis for the next phase of development which focused on the development of Discipline Specific indicators for health and social care professionals providing more than generalist palliative care. To proceed with the discipline specific work, a number of Development Working Groups were established in order to develop indicators for each distinct discipline (Phase 1). Over the period from August (2012) to February (2013) development working groups for Medicine, Social Work, Physiotherapy, Occupational Therapy and Pharmacy, met to develop discipline specific indicators. The Development Working Group for Nursing, Midwifery and Health Care Assistants emerged from an already constituted group that had been brought together for a related project. This group was assisted in the work of developing discipline specific indicators within the divisions of nursing and midwifery and for health care assistants, by a project team from the School of Nursing and Midwifery at Trinity College Dublin led by Dr Honor Nicholl and funded by the Irish Hospice Foundation and the Office of the Director of Nursing and Midwifery Services HSE. Discipline Specific Working Groups were established in January 2013 to facilitate work with Speech and Language Therapy and Dietetics/Clinical Nutrition (Phase 2), and in January 2014 to facilitate work with Psychology and Chaplaincy/ Patoral Care. The Working Groups for these disciplines met over a period of several weeks to develop discipline specific indicators. Their work concluded in March 2013 and April 2014 respectively. The context of the Palliative Care Competence Framework The complexity of the health care system sometimes leads to fragmented services and care and collaborative practice has a vital role in enhancing continuity of care for people with life-limiting conditions. This is particularly true in the context of caring for people with life-limiting conditions who may access services from multiple agencies and have a range of complex care needs that require attention. In most cases these complex needs are using a multidisciplinary approach to care that includes opportunities for discussions and care planning with members of the multidisciplinary team. Multidisciplinary care is characterised by a collaborative and person-centred approach to care planning and delivery and can lead to the achievement of realistic care goals. The multidisciplinary approach to care can lead to increased individual satisfaction with care and increase perception that the care of the individual with a life-limiting condition and their family is being managed by a team. The multidisciplinary approach to care can also ensure access to information and support for the person with a life-limiting condition and their family. It is important to note that the Palliative Care Competence Framework recognises that health and social care professionals adhere to professional codes of conduct and guidelines and may also be required to work within an employer organisation s ethos, policies and practice. Domains of Competence The Domains of Competence are: Domain of Competence 1 - Principles of palliative care Domain of Competence 2 - Communication Domain of Competence 3 - Optimising comfort and quality of life Domain of Competence 4 - Care planning and collaborative practice Domain of Competence 5 - Loss, grief and bereavement Domain of Competence 6 - Professional and ethical practice in the context of palliative care 15

16 Introduction Each Domain of Competence is defined with a statement. The core competences are common to all health care professionals and represent the primary level of understanding required to provide Palliative Care, also described as using the Palliative Care Approach in daily work. The domain statement remains the same irrespective of the level at which or the setting where palliative care is provided. However the domain indicators outline the competences required by health care professionals in the context of their role and at the level at which palliative care is provided irrespective of care setting. In the context of the Palliative Care Competence Framework the level of expertise is key and is influenced by the critical mass of individuals treated, advanced palliative care knowledge, understanding and skills, the currency of this knowledge and maintenance of palliative care evidence base, access to on-going palliative care clinical, multidisciplinary expertise in the daily work environment and involvement in the area of education and professional development at local and national level. ALL In the context of individual disciplines, further indicators are identified for ALL. These reflect the particular competences required for that discipline at point of registration or related to current role. The indicators are applicable irrespective of the care setting or the staff grade. The goal is competence to provide care using a palliative care approach. SOME - Specific Competences are for SOME health care professionals irrespective of the care setting or the staff grade. The goal is the provision of care applying the principles of palliative care and using a palliative care approach. This is achieved through additional preparation for professional practice and increased clinical engagement with people with life-limiting conditions, developing deeper knowledge, understanding and application of competences in palliative care. FEW - Discipline Specific Competences are for FEW health care professionals irrespective of the care setting or the staff grade, whose core activity is limited to the provision of palliative care. The competences at this level are those required for the care of individuals with complex and demanding palliative care needs. The goal is to demonstrate knowledge and application of palliative care skills at specialist level. ALL Competences are for ALL health and social care professionals irrespective of the care setting or the staff grade. The goal is competence to provide care using a palliative care approach. SOME Specific Competences are for SOME health and social care professionals irrespective of the care setting or the staff grade. The goal is the provision of care applying the principles of palliative care and using a palliative care approach. FEW Discipline Specific Competences are for FEW health and social care professionals irrespective of the care setting or the staff grade, whose core activity is limited to the provision of palliative care. The competences at this level are those required for the care of individuals with complex and demanding palliative care needs. The goal is to demonstrate knowledge and application of palliative care skills at specialist level. Figure 1: Competence Framework Model adapted from Australian Model for Nursing in Cancer Control 16

17 Core Competences for Palliative Care DOMAIN OF COMPETENCE 1 - PRINCIPLES OF PALLIATIVE CARE Palliative care aims to improve the quality of life of people with life-limiting conditions and their families, not only by treating their physical symptoms but also by attending to their psychological, social and spiritual needs. Palliative care is applicable for people of any age and may be integrated at any point in the disease trajectory from diagnosis through the continuum of care to bereavement. Indicators As a health care professional you should: Understand and be able to describe the meaning of the term life-limiting condition Understand and be able to apply the principles of palliative care that affirm life, offer people with life-limiting conditions a support system to help them live as actively as possible until death with optimal quality of life and help families cope during illness Understand the significance of the physical, psychological, social and spiritual issues that affect people with lifelimiting conditions and their families throughout the continuum of care Demonstrate the ability to use the palliative care approach as early as is appropriate in order to facilitate personcentred practice that recognises the concerns, goals, beliefs and culture of the person and her/his family Provide empathetic care to individuals with life-limiting conditions and their families, with clear regard to the individuality of each person Show a commitment to one s own continued professional development and learning and facilitate the learning and development of others, in order to improve care for those with life-limiting conditions and their families Show a commitment to developing self-care strategies and to attending to any impact that working with people facing life-limiting conditions and their families may have on you. DOMAIN OF COMPETENCE 2 - COMMUNICATION Effective communication is essential to the application of palliative care principles and to the delivery of palliative care. Communication is also important where circumstances are ambiguous or uncertain and when strong emotions and distress arise. Specific consideration should be given to communication as a method of: Supporting and enabling therapeutic relationships with the person with a life-limiting condition and her/his family; Ensuring that the person and her/his family understand and participate in decision-making regarding care to the extent that she/he is able to and wishes to be involved Enabling inter-professional teamwork. Indicators As a health care professional you should: Understand the essential role communication plays in palliative care Understand the different types of communication e.g. verbal, non-verbal, visual, written, and interpersonal interaction (either one-to-one or with a group or team) Demonstrate the ability to communicate effectively with the person with a life-limiting condition, their family and the interdisciplinary team in order to establish, maintain and conclude a therapeutic relationship Demonstrate the ability to communicate effectively with individuals and families from diverse cultures and different backgrounds, using professional interpreters (Appendix 1) where necessary and/or assistive communication technology where necessary Be able to modify your own communication style to facilitate communication with individuals with a range of communication impairments or seek facilitation in this area if required. Understand the importance of using strategies that empower effective communication e.g. active listening, plain language, appropriate tone, clarifying statements, inviting questions Demonstrate an ability to be attentive to the person through careful listening to help the person and their family feel they have been heard Support individuals (or parents in the case of children and minors) to make informed decisions regarding the level of information they wish to receive and want to share with their family Act as an advocate for the person and their family to ensure appropriate and timely palliative care intervention 17

18 Introduction DOMAIN OF COMPETENCE 3 - OPTIMISING COMFORT AND QUALITY OF LIFE Individuals with life-limiting conditions and their families can be affected not only in physical, but also in psychological, social and spiritual ways. Optimising comfort and quality of life for the person with a life-limiting condition and her/his family is a dynamic process that involves anticipating, acknowledging, assessing and responding to a range of symptoms and needs in a proactive and timely manner in order to prevent and relieve suffering. Indicators As a health care professional you should: Understand the significance of anticipating and responding to the needs of people with life-limiting conditions and their families (e.g. physical, psychological, social and spiritual) in a proactive and timely manner Understand how the palliative care approach can enhance the assessment and management of symptoms Exhibit an ability to apply a range of assessment tools to gather information Be able to evaluate non-complex interventions and propose alternative actions if deemed necessary Recognise the importance and benefit of multidisciplinary working in optimising comfort and enhancing the quality of life of the person with a life-limiting condition and her/his family Recognise the ways in which people with life-limiting conditions and their families can be engaged in self-management of their condition Demonstrate professional awareness of the scope of, and benefits of timely and appropriate access to specialist palliative care services Be aware of the uniqueness of a good death and facilitate the achievement of this as much as possible DOMAIN OF COMPETENCE 4 - CARE PLANNING AND COLLABORATIVE PRACTICE Care planning in palliative care is characterised by coordinating and integrating person-centred care in order to promote quality of life for people with life-limiting conditions and their families. It involves assessing need, promoting and preserving choice, predicting likely problems and planning for the future in the context of a changing and deteriorating disease trajectory. Care planning ensures that multiple disciplines and agencies can be accessed and referred to as required in a timely manner. People with life-limiting conditions should be helped to engage with care planning to the extent that they are able to and wish to be involved. The concerns of families and carers should be taken into account as part of this process. Indicators As a health care professional you should: Recognise the impact of a life-limiting condition on the person and her/his family and be able to provide support in order to help the individual to adapt to the changes in her/his condition Recognise the impact of a life-limiting condition on the person and her/his family s mental health and coping mechanisms and be able to provide support in order to help the individual to adapt to the bereavement and loss Appreciate the roles, responsibilities and professional boundaries of individual members of the interdisciplinary team Understand the collaborative relationship between the person with life-limiting conditions, the health care professional, the family and all the other agents of care involved with the person and the family in order to develop an individualised and coherent plan of care to assist the person and the family to attain realistic goals and outcomes in all care settings Collaborate effectively with others as a member or leader of a multidisciplinary team Be able to identify priorities or concerns for the individual with a life-limiting condition and their carers, taking account of the individual s coping strategies and how the person perceives their diagnosis In the context of professional scope of practice be able to critically evaluate outcomes of interventions against established standards and guidelines Demonstrate an understanding of advance care planning and an appreciation of the appropriate time(s) to engage in discussions about preferences for care with the person with a life-limiting condition and her/his family Demonstrate an ability to communicate sensitively and clearly about advance care planning with the person, the family and the range of professionals and agencies involved. 18

19 Introduction DOMAIN OF COMPETENCE 5 - LOSS, GRIEF AND BEREAVEMENT Dealing with loss, grief and bereavement for the person themselves, their family and the professionals who care for them is intrinsic to palliative care provision. Most people manage their loss by combining their own resources with support from family and friends. However, a minority of people are at risk of developing complications or difficulties in their grieving. Professionals using the palliative care approach have an important role to play in supporting bereaved people by providing information and support to all and by identifying those who require bereavement therapy or counselling. Indicators As a health care professional you should: Understand that grief is a normal and appropriate response to loss which has physical, psychological, spiritual, emotional and social aspects that affect how it is experienced Recognise the range of individual physical, psychological, spiritual, emotional and social responses to loss and grief Recognise the factors which may put a person at risk of encountering difficulties in their grief, whilst also remaining aware of the resources and resiliencies that are particular to each person and family Demonstrate an ability to engage with a person who is experiencing loss in the context of professional scope of practice and/or role Assist the family to access bereavement information and support at a level that is appropriate to their needs Be cognisant of the psychological impact of death and dying on individuals with increased stress vulnerability Understand the personal impact of loss, grief and bereavement and recognise your own loss responses and engage in activities that maintain your resilience on an on-going basis Possess a level of self-awareness that prevents your own experiences of loss from negatively impacting on the person with a life-limiting condition or their family. DOMAIN OF COMPETENCE 6 - PROFESSIONAL AND ETHICAL PRACTICE IN THE CONTEXT OF PALLIATIVE CARE The goal of health care is to help people sustain health that is essential to their well-being. However, there comes a time when specific treatments or interventions may be futile or overly burdensome. Integrity in palliative care practice refers to the importance of respecting the person s values, needs and wishes in the context of a life-limiting condition. It guides all health care professionals to reflect on the relationship between their contribution to a person s care and the necessary contributions of other professionals. Professional and ethical practice is about considering how best to provide continuing and integrated care to people as their health care needs change in the course of life-limiting conditions. Indicators As a health care professional you should: Work within your current Code of Professional Conduct and engage ethically, knowledgably and respectfully with other disciplines. Recognise and respect your professional responsibility to care for people with life-limiting conditions and their families to ensure their comfort and dignity In the context of your current professional role establish collegial partnerships and in the context of palliative care contribute to the professional development of students, peers, colleagues and others through consultation, education, leadership, mentorship and coaching Use the resources available fairly in the context of providing appropriate care to the person with a life-limiting condition In the context of professional scope of practice and/or role anticipate and demonstrate the ability to address potential ethical issues that may be encountered when caring for the person with a life-limiting condition and her/his family such as: Do Not Attempt Resuscitation Orders, withdrawal and withholding of treatment, use of artificial hydration and feeding, palliative sedation and requests for euthanasia Be able to establish and respect person s wishes about their care and options/ preferences. This includes: Recognising the person s right to make informed decisions to refuse additional treatment(s) Seeking, responding to and implementing people s preferences about where they are cared for (e.g. in their own homes) if this is practicable Respecting advance care plans made by people where the decision is an informed choice and relates to the situation that has arisen (Medical Council, 2009) Demonstrate a commitment to engage in anti-discriminatory practice in relation to end of life care and service delivery 19

20 DISCIPLINE SPECIFIC COMPETENCES MEDICINE 20

21 MEMBERSHIP OF DISCIPLINE SPECIFIC WORK GROUP: MEDICINE Dr Regina McQuillan (Chair) Palliative Medicine Consultant, St. Francis Hospice and Beaumont Hospital Dr Cathryn Bogan Palliative Medicine Consultant, Northwest Hospice, Sligo Dr Miriam Colleran Palliative Medicine Consultant, Naas General Hospital and St. Brigid s Hospice, Kildare Dr Michael Connolly Head of Education, All Ireland Institute of Hospice and Palliative Care Dr Anne Horgan Consultant Oncologist, Waterford Regional Hospital Dr Sarah McLean Specialist Registrar, Palliative Medicine Dr Niamh O Connor Specialist Registrar, Palliative Medicine Dr Karen Ryan Palliative Medicine Consultant, St. Francis Hospice and Mater Misericordiae University Hospital Dr Denise Sadlier Consultant Nephrologist, Mater Misericordiae University Hospital Dr Catherine Sweeney Medical Director, Services for Older People. St. Patrick s Hospital, Cork/Lecturer Clinical Science and Practice, School of Medicine, University College Cork Dr Emmet Walls Palliative Medicine Consultant, Waterford Regional Hospital 21